Aim: The present study aimed to evaluate the validity of proxy informants' reports on Life Event Scale for the Elderly (LESE) by using psychological autopsy method among rural older adults in China.Methods: A multistage stratified cluster sampling method was used to select research sites. Using a case-control psychological autopsy study, face-to-face interviews were carried out to collect information from 242 suicide cases and 242 living controls. We compared the intensity and number of life events to assess the validity and reliability of LESE with proxy data reported by different informants. Data from proxy respondents of the living controls were compared with data reported by the targets (gold standards). Intraclass correlation coefficients were computed to evaluate the consistency of informants. Spearman's correlation analysis was used to analyze the convergent validity and discriminate validity of the LESE.Results: The number of life events between different informants showed higher intraclass correlation coefficients values than the intensity of life events, but the results of correlation analysis was similar. The LESE was positively correlated with depression, loneliness and hopelessness, and negatively correlated with quality of life, family function and social support both in suicide cases and living controls. Conclusions:The LESE has good convergent validity and discriminant validity. LESE is a valid instrument for measuring life events in psychological autopsy studies. We suggest using the number of life events to assess the validity and reliability with proxy data in a psychological autopsy study, which is more reliable than using the intensity of life events. Geriatr Gerontol Int 2019; 19: 547-551.

BackgroundAfter the first COVID-19 case detected on 8 December 2019 in Wuhan, the Provincial Capital of Hubei, the epidemic quickly spread throughout the whole country of China. Low developmental levels are often associated with infectious disease epidemic, this study attempted to test this notion with COVID-19 data.MethodsData by province from 8 December 2019 to 16 February 2020 were analysed using regression method. Outcomes were days from the first COVID-19 case in the origin of Hubei Province to the date when case was first detected in a destination province, and cumulative number of confirmed cases. Provincial gross domestic products (GDPs) were used to predict the outcomes while considering spatial distance and population density.ResultsOf the total 70 548 COVID-19 cases in all 31 provinces, 58 182 (82.5%) were detected in Hubei and 12 366 (17.5%) in other destination provinces. Regression analysis of data from the 30 provinces indicated that GDP was negatively associated with days of virus spreading (β=−0.2950, p<0.10) and positively associated with cumulative cases (β=97.8709, p<0.01) after controlling for spatial distance. The relationships were reversed with β=0.1287 (p<0.01) for days and β=−54.3756 (p<0.01) for cumulative cases after weighing in population density and controlling for spatial distance.ConclusionHigher levels of developmental is a risk factor for cross-province spread of COVID-19. This study adds new data to literature regarding the role of economic growth in facilitating spatial spreading of infectious diseases, and provides timely data informing antiepidemic strategies and developmental plan to balance economic growth and people’s health.

Background There is a lack of evidence concerning the stressful life events experienced prior to suicide which may be associated with an increased suicide risk among Chinese rural older adults. The aim of this study was to identify the pattern of stressful life events prior to suicide among the older adults in China. Methods Twelve counties were randomly selected using two-stage stratified cluster sampling method. Suicide cases aged 60 years and older (n = 242) were collected from those counties from June 2014 to September 2015. Matched living controls were selected 1:1 with suicide cases by age, gender, and location. Data were collected using face-to-face interviews by a psychological autopsy method. The Life Event Scale for the Elderly was used to measure the stressful life events prior to suicide/interviews. Results Approximately 99.6% of suicide cases and 88.4% of controls experienced at least one stressful life event. The suicide group experienced more long-term stressful life events than recent stressful life events. The top three most frequent stressful life events for the suicide group were being diagnosed with chronic disease, hospitalization, and being diagnosed with terminal illness. More female suicide cases experienced the death of a spouse, while more males experienced hospitalization, diagnosis with terminal illness and family poverty. Experiencing at least one stressful life event, an unstable marital status, physical diseases and mental disorders were shown to increase the risk of suicide. Conclusions Stressful life events were common for the rural older adults, especially long-term stressful life events. The experience of at least one stressful life event can increase suicide risk among this population. More attention should be paid to the rural older adults who experienced more long-term stressful life events and health related life events.

Abstract. Background: Suicide is a complex public health problem. Suicide rates are higher in rural areas than in urban areas and among older adults than any other age group in China. Aims: This study aimed to acquire a comprehensive understanding of rural older adults’ reasons for suicide through qualitative exploration and to provide additional insights for suicide prevention work. Method: In-depth interviews were conducted with people familiar with older adults who had died by suicide (“informants”). The data were analyzed using a thematic approach. Results: Data were available for 242 people who died by suicide. Informants identified two or more reasons for suicide among most people who had died. Physical illness, psychological distress, and interpersonal conflicts were the most common reasons. The rate of mental disorders as diagnosed by psychiatrists was higher than that reported by the informants. Limitations: Information bias is inevitable because of the use of proxy informants. Conclusion: The reasons for suicide are complex and diverse, and research on suicide should focus more on the mechanisms of interaction between reasons. Greater attention should be paid to physical and mental health as well as to improving interpersonal and problem-solving skills for older adults in China.